Peter Allebeck

Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study

Abstract Objectives: An association between use of cannabis in adolescence and subsequent risk of schizophrenia was previously reported in a follow up of Swedish conscripts. Arguments were raised that this association may be due to use of drugs other than cannabis and that personality traits may have confounded results. We performed a further analysis of this cohort to address these uncertainties while extending the follow up period to identify additional cases. Design: Historical cohort study. Setting: 1969-70 survey of Swedish conscripts (>97% of the countrys male population aged 18-20). Participants: 50 087 subjects: data were available on self reported use of cannabis and other drugs, and on several social and psychological characteristics. Main outcome measures: Admissions to hospital for ICD-8/9 schizophrenia and other psychoses, as determined by record linkage. Results:Cannabis was associated with an increased risk of developing schizophrenia in a dose dependent fashion both for subjects who had ever used cannabis (adjusted odds ratio for linear trend of increasing frequency 1.2, 95% confidence interval 1.1 to 1.4, P<0.001), and for subjects who had used only cannabis and no other drugs (adjusted odds ratio for linear trend 1.3, 1.1 to 1.5, P<0.015). The adjusted odds ratio for using cannabis >50 times was 6.7 (2.1 to 21.7) in the cannabis only group. Similar results were obtained when analysis was restricted to subjects developing schizophrenia after five years after conscription, to exclude prodromal cases. Conclusions: Cannabis use is associated with an increased risk of developing schizophrenia, consistent with a causal relation. This association is not explained by use of other psychoactive drugs or personality traits relating to social integration. What is already known about this topic Use of cannabis has been associated with an increased risk of developing schizophrenia Alternative explanations for this association include confounding by personality or by use of other drugs such as amphetamines, and use of cannabis as a form of self medication secondary to the disorder What this study adds Self reported cannabis use is associated with an increased risk of subsequently developing schizophrenia, consistent with a causal relation This association is not explained by sociability personality traits, or by use of amphetamines or other drugs Self medication with cannabis is an unlikely explanation for the association observed

Burden of illness and suicide in elderly people: case-control study

Abstract Objectives: To study the association between physical illness and suicide in elderly people. Design: Case-control with illness determined from interviews with relatives of people who committed suicide and with control participants and from medical records. Setting: Gothenburg and two surrounding counties (210 703 people aged 65 years and over). Participants: Consecutive records of people who had committed suicide and had undergone forensic examination (46 men, 39 women) and living control participants from the tax register (84 men, 69 women). Main outcome measures: Physical illness rated in 13 organ systems according to the cumulative illness rating scale-geriatrics; serious physical illness (organ category score 3 or 4); overall score for burden of physical illness. Results: Visual impairment (odds ratio 7.0, 95% confidence interval 2.3 to 21.4), neurological disorders (3.8, 1.5 to 9.4), and malignant disease (3.4, 1.2 to 9.8) were associated with increased risk for suicide. Serious physical illness in any organ category was an independent risk factor for suicide in the multivariate regression model (6.4, 2.0 to 20.0). When the sexes were analysed separately, serious physical illness was associated with suicide in men (4.2, 1.8 to 9.5) as was high burden of physical illness (2.8, 1.2 to 6.5). Such associations were not seen in women, possibly because of the small sample size. Conclusions: Visual impairment, neurological disorders, and malignant disease were independently associated with increased risk of suicide in elderly people. Serious physical illness may be a stronger risk factor for suicide in men than in women.

Young cases of schizophrenia identified in a national inpatient register: Are the diagnoses valid?

Abstract.Background: Psychiatric inpatient registers are often used in research in the Nordic countries. We aimed to investigate the validity of recorded diagnoses of schizophrenia in the Swedish National Inpatient Register, in cases of early age at onset. We also wanted to describe the accuracy of the diagnoses in cities/university clinics and country hospitals as well as in child and adolescent psychiatric clinics and clinics for adults. Method: One hundred cases with a diagnosis of schizophrenia, born 1973–1977, were randomly selected. The psychiatric records were scrutinised according to the criteria of DSM-IV. Results: Eighty-six per cent (95 % CI 78–93 %) fulfilled the DSM-IV criteria of schizophrenia syndrome and 76 % (95 % CI 66–86 %) fulfilled the “narrow” definition. There were no large differences in the accuracy of the diagnoses between regions or clinics. Conclusion: The proportion of “true” cases of schizophrenia is high in the Swedish National Inpatient Register. In addition, the results did not support large differences between clinics or regions although a larger sample size would be needed to test this formally. In comparison with earlier studies from the Nordic countries the validity seems to be quite stable over time, between different ages at onset and between Nordic countries. Thus, the registers are well suited to be used in schizophrenia research.

Suicide in first- and second-generation immigrants in Sweden A comparative study

Background: Studies of suicide in first-generation immigrants have consistently shown higher rates compared to their country of origin. Little is known about the risk of suicide in second-generation immigrants and intercountry adoptees. The aim of this study was to investigate rates of suicide death in second-generation immigrants and intercountry adoptees in comparison with their parental generation and the majority population. Method: The study was based on multivariate analyses of register data on suicide death during 1990–98 in a Swedish national cohort of 2.7 million residents (10–68 years). Results: Second-generation immigrants tended to have higher odds than the first-generation immigrants compared to the majority population in all six minority groups studied. The Finnish minority had the highest and the Middle Easterners the lowest odds for suicide death in both generations of immigrants. The intercountry adoptees had very high odds for suicide death (adjusted OR: 5.0; 95 % CI 3.5–7.0). Conclusions: Second-generation immigrants are at greater risk for suicide death than their parental generation. Intercountry adoptees should be of particular concern in suicide prevention.

Cannabis and schizophrenia: a longitudinal study of cases treated in Stockholm County

By means of the Stockholm County inpatient care register we identified all cases treated with a diagnosis of cannabis dependence and psychosis, not necessarily at the same occasion, during 1971–1983. By scrutinizing medical records, we evaluated the diagnosis according to DSM‐III‐R and we assessed the history of substance abuse as well as the psychiatric history and clinical course. We identified 229 cases during the follow‐up; 112 of these cases (49%) fulfilled the DSM‐III‐R criteria for schizophrenia. The majority of the schizophrenics had prominent positive symptoms and a sudden onset of disease, and 69% of the cases had a record of heavy cannabis abuse at least 1 year before onset of psychotic symptoms. The high number of verified DSM‐III‐R cases of schizophrenia in this cohort and the temporal relation between cannabis abuse and schizophrenia further support the hypothesis that cannabis abuse may be a risk factor for schizophrenia. We confirmed previous observations that cannabis‐associated schizophrenia often has a sudden onset and prominent positive symptoms.

Elderly people's perspectives on quality of life

Quality of life has become increasingly important as an outcome in medical research. The influence of health status is often emphasised, but other dimensions are important. In order to improve quality of life, there is a need to know what people themselves consider important to their perception of quality of life. The aim of this study was to investigate what older people consider to be important for their quality of life, and to explore the impact of gender, education and health status on individual perceptions. The study was of 141 randomly selected people aged from 67 to 99 years that formed a control sample for a study of suicide among older people. They were interviewed in person about their health, socio-demographic background and, using an open-ended question, what they considered to constitute quality of life. Their answers were grouped into eight categories, with social relations being the most frequent response, followed by health, activities, functional ability, wellbeing, personal beliefs and attitudes, their own home and personal finances. In addition, they were asked to choose from a ‘show card’ three items that they regarded as important to quality of life. Functional ability was the most frequently selected domain, followed by physical health, social relations and being able to continue to live in ones present home. Our conclusion is that social relations, functional ability and activities influence the quality of life of elderly people as much as health status.

Attitudes and Behaviors with Regards to Androgenic Anabolic Steroids Among Male Adolescents in a County of Sweden

Aims. The aim of this study was to investigate attitudes towards androgenic anabolic steroids among male adolescents who have used anabolics compared to those who have not. Design and Setting.u2002A cross-sectional survey was performed in the year 2000 in all secondary schools in the county of Halland on the west coast of Sweden. Participants and Measurements.u2002An anonymous multiple-choice questionnaire was distributed to all classes with 14-, 16-, and 18-year-old male adolescents. The response rate was 92.7% (n = 4049). Findings. Those who admitted having used androgenic anabolic steroids differed in several ways from those who had not. Fewer believed androgenic anabolic steroids to be harmful [odds ratio (OR) = 0.15, 95% CI 0.08–0.30] and more believed that girls preferred boys with large muscles (OR = 6.1, 95% CI 3.4–11.0). They trained more often at gyms (OR = 5.6, 95% CI 3.0–10.6), drank more alcohol (OR = 4.2, 95% CI 2.0–9.1), and had used narcotic drugs more often (OR = 15.3, 95% CI 8.5–27.5) than the other male adolescents. More immigrants than native-born adolescents had used anabolics (OR = 4.2, 95% CI 2.2–7.9). Conclusion. Attitudes towards anabolics differ between users and nonusers. These aspects may be beneficial to focus on as one part of a more complex intervention program in order to change these attitudes and decrease the misuse of androgenic anabolic steroids.

Psychosocial characteristics in young men as predictors of early disability pension with a psychiatric diagnosis.

Background: There is little knowledge about disability pensions (DPs) in psychiatric diagnoses. The aim of this study was to analyse risk factors among men for receiving an early disability pension with a psychiatric diagnosis. Methods: The study is based on data from a nationwide survey of 49 285 young Swedish men who were conscripted into military service in 1969/1970. Potential psychosocial and behavioural risk factors were linked to records from the Swedish Social Insurance Board up until 1993. Results: The majority (63.4%) of the men granted a DP during follow-up had a psychiatric diagnosis as the main and/or secondary diagnosis. Among those conscripts analysed (41 702), 599 had been granted a disability pension with a psychiatric diagnosis. Of these, 35.4% had a diagnosis of psychosis, 23.2% an alcohol- or drug-related diagnosis, and 41.4% `other psychiatric diagnosis. Receiving a psychiatric diagnosis at conscription, showing low emotional control, unemployment after graduation, and ranking low on an “IQ” test were strong predictors of all categories of DP with psychiatric diagnoses. In multivariate analysis controlling for the effect of all other risk indicators included in the model, DP with non-alcohol- and non-drug-related psychiatric diagnoses was related to low social support at adolescence but not to signs of extrovert deviant behaviour (risky use of alcohol or contact with police and child authorities). In contrast, DP with an alcohol- or drug-related diagnosis had strong associations with signs of extrovert deviant behaviour. The risk pattern of DP without psychiatric diagnoses was similar to that of DP with a psychosis but also, though to a lesser extent, to that of DP with `other psychiatric diagnosis. These similarities could be interpreted as showing that the diagnoses on the records of disability pensions have a low sensitivity and/or specificity or, alternatively, that the risk factors found are risk factors for life careers steering toward a disability pension rather than toward the specific health outcomes per se. Conclusions: The results illustrate the importance of psychosocial factors established in late adolescence in the complex pathway of a decision of an early DP.

Migration, ageing and mental health: an ethnographic study on perceptions of life satisfaction, anxiety and depression in older Somali men in east London

This ethnographic study was carried out in the aftermath of an epidemiological investigation, the first of its kind, on the health and social status of Somalis aged 60 years and over living in Tower Hamlets, east London. The main aims of the study are to explore views on mental health and well-being and identify sources of stress and support so as to gain greater understanding of background factors of life satisfaction and depression in ‘first-generation’ older Somali migrants in Tower Hamlets (males). Face-to-face interviews were conducted among 28 males in Somali with the help of a bilingual interpreter from the same age, sex and cultural background of participants. Several factors were perceived to decrease life satisfaction and increase vulnerability to depression in male Somalis, in particular low family support in the face of increasing physical disability, loneliness, inadequate access to community services and inability to return home. Social isolation, low level of control over ones life, helplessness and social degradation – ageism, perceived racial/religious discrimination and, to a lesser extent, racial harassment – were common themes identified in people who said to be depressed. Family support was the main buffer against depression; other coping resources were represented by religious practices and reliance on Somali peers. Avoidance coping seemed to encompass denial of depression in participants who had low mood. The study revealed multiple reasons for ill-being, in particular in people who had high expectations about medical and social care. Low levels of distress were found in Somalis who felt supported by their families. There is a need for social workers and other health professionals to advance discussions of mental-health issues in the community and for service providers to promote greater access to culturally relevant medical and social services for Somali elders in Tower Hamlets and strengthen their informal support networks.

Health and well-being among 70-year-old migrants living in Sweden – results from the H 70 gerontological and geriatric population studies in Göteborg

Background Comparative epidemiological studies in migrants in Sweden have shown increased prevalence of psychosocial morbidity in young adults, but there is paucity of information on health in people aged 65 years and over. Aims We aim to compare prevalence of mental, physical and social health problems, rates of hospital admission, and mortality in Swedish and non-Swedish born people aged 70 years living in Göteborg, Sweden, and examine associations between social factors, physical health, mood and life satisfaction in the ethnic groups. In addition, we aim to test for the hypothesis that differences in mental health between migrants and natives are explained by social disadvantages rather than ethnicity. Method Semi-structured interviews were administered to 84 migrants (47 women and 37 men randomly selected) with the help of bilingual interpreters, and 409 Swedes (183 males and 226 females) used as “controls”. Complementary health and social data obtained from official sources on the total sample (N = 764, including non-participants in overall medical interviews) were used in comparative analyses of in-patient care and mortality and to check for the possibility of sampling bias. Results Migrants – originating mainly from Estonia, Poland, Yugoslavia, Germany, Italy and Nordic countries other than Sweden – reported more dizziness, poor vision and urinary problems, and fewer gall bladder problems than indigenous people (p ≤ 0.05). Migrants also had higher levels of anxiety and depression and bodily pain, and lower levels of general health, social and emotional functioning, satisfaction with physical health status, family contacts, housing conditions and economic status than natives (p ≤ 0.05). Satisfaction with physical health seemed to be one of the strongest factors related to a lower prevalence of anxiety and depression together with family support and time spent in leisure pursuits. No significant differences in in-patient care in several ICD categories and all-cause mortality were found between overall migrants and the control group notwithstanding differences in self-reported health. Conclusion The results indicate poorer subjective health in older migrants than natives in Göteborg, and also point to a “healthy migrant” effect on survival.